Open To Work
Cristy Peck
Provider Relations
Springfield,MO
Summary
Provider Relationship Account Consultant with extensive experience in Provider Relations and Contract Management. Focused on fostering strong provider partnerships, resolving operational challenges, and delivering effective training. Committed to enhancing provider satisfaction and optimizing network performance through data-driven insights and cross-functional collaboration.
Overview
22
22
years of professional experience
Work History
Provider Relationship Account Consultant
Elevance Health
Springfield, USA
11.2019 - Current
- Serve as a subject matter expert on referrals, authorizations, claims, credentialing, and reimbursement, supporting both providers and internal stakeholders.
- Managed relationships with large network of providers, led partnership meetings, and resolved complex operational and claims-related issues.
- Researched and resolved complex provider issues, including contract discrepancies, billing concerns, and claims processing challenges, ensuring timely resolution.
- Partner cross-functionally with internal teams to improve workflows, submit work requests, and enhance service delivery.
- Handle a high volume of provider inquiries across multiple channels while maintaining strong service levels and responsiveness.
- Developed and delivered provider education and training on policies, tools, and processes, enhancing understanding and minimizing recurring issues.
- Create and distribute communication materials across multiple lines of business to ensure consistent provider messaging.
Provider Partnership Associate
Home State Health
Springfield, USA
04.2017 - 11.2019
- Collaborated with providers and health plan to resolve inquiries via phone and email, enhancing communication and support.
- Conducted initial provider orientations and ongoing educational outreach to ensure understanding of policies and procedures.
- Educated providers on referrals, authorizations, claims submission, credentialing, contract language, reimbursement, and website tools.
- Investigated and resolved provider matters, ensuring timely resolutions that strengthened relationships.
- Conducted HBR and HEDIS analyses, generating performance reports for providers using quantitative and qualitative metrics to inform improvements.
Revenue Management Specialist
Medical Consulting Group
09.2013 - 04.2017
- Managed accounts receivable processes, streamlining billing, collections, and payment posting.
- Developed reports and analyzed financial and operational data to identify trends and growth opportunities.
- Supported strategic planning initiatives with data-driven insights and actionable recommendations.
- Verified insurance eligibility and benefits, enhancing billing accuracy and minimizing denials.
Contract/User Application/Reimbursement Specialist
Mercy Health Plans
Springfield, USA
08.2004 - 08.2013
- Managed payer and employer contracts post-negotiation, ensuring accurate implementation and compliance.
- Maintained contract data and evaluated performance, identifying key opportunities for improvement.
- Resolved complex claims issues by developing claim logic that enhanced processing accuracy.
- Executed financial adjustments and reconciliations while following up on outstanding claims to ensure timely resolution.
- Supported system enhancements and troubleshooting for claims processing platforms.
Education
Nursing - Certification
Ozark Technical College
Springfield, MO05-1998
High School Diploma -
Glendale High School
Springfield, MO05-1998
Skills
- Customer Relationship Management
- Health Plan Operations
- Contract Management
- Revenue Cycle Management
- Data analysis
- Root Cause Analysis
- Provider training
- Cross-Functional Collaboration
- Presentation development
- Customer service
- Claims management
- MS office
- Attention to detail
- Data entry
- Regulatory compliance
- Verbal and written communication
- Microsoft Excel
- Reports reconciliation
- Business correspondence
- Data-driven decision making
Summary Of Qualifications And Skills
Healthcare & Regulatory Expertise Federal and State Program Regulations, Health Plan Operations, Proficient in HEDIS tech specs, NCQA Accreditation
Systems & Tools Microsoft Office Suite (Excel, Word, PowerPoint, SharePoint, Teams, Access)
Provider Management Systems (CAQH, Availity, SPS, Salesforce, Maces, Tableau, Compass, ASPEN, Citrix, PEGA, Provider Contract Repository, Contraxx, InterAct, Solutions Central, Adhoc Reporting, Salesforce)
Claims Processing Software (Facets, WGS, Phoenix, Amisys, Cenprov, CI&W, QuickBooks, Vision, Kareo, Cirius, IDX, EPIC, AdvantX, EClinicalWork.
Training: Lean Six Sigma White and Yellow Belt, CURES, Agil Foundations, Provider Engagement Training, Presentations Skills, CAHPS, Leadership Development Program, and served on the Transformation Change Network Program.
Work Preference
Job Search Status
Open to workWork Type
Full TimeLocation Preference
RemoteSalary Range
$70000/yr - $200000/yrTimeline
Provider Relationship Account Consultant
Elevance Health
11.2019 - Current
Provider Partnership Associate
Home State Health
04.2017 - 11.2019
Revenue Management Specialist
Medical Consulting Group
09.2013 - 04.2017
Contract/User Application/Reimbursement Specialist
Mercy Health Plans
08.2004 - 08.2013
Nursing - Certification
Ozark Technical College
High School Diploma -
Glendale High School